Basic Information
| Provider Information | |||||||||
| NPI: | 1346787587 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MPB SPORTS AND REHABILITATION INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3048 NW 29TH AVE | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334346036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542901404 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3048 NW 29TH AVE | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334346036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542901404 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2017 | ||||||||
| LastUpdateDate: | 01/26/2017 | ||||||||
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| AuthorizedOfficialLastName: | BONAROS | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9542901404 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MSPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 21438 | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.